Tau-PET imaging and blood biomarkers reveal early tauopathy in special operations forces exposed to repetitive blast.

Repeated low-intensity blast overpressure exposures, frequently sustained by Special Operations Forces during breaching, combat training, and weapons use, are thought to initiate tau-related neurodegenerative changes that may remain clinically silent for years. The long-term impact of cumulative blast overpressure on brain health is poorly understood, and sensitive biomarkers are needed for early detection and monitoring of subclinical injury in high-risk populations. In this cross-sectional study, 25 actively serving male Canadian Special Operations Forces personnel (mean [SD] age, 43.6 [6.1] years) with ≥16 years of breaching and explosives experience were compared with 10 age-matched Canadian Armed Forces controls (mean [SD] age, 39.8 [6.8] years) with minimal blast exposure. All participants underwent [18F]flortaucipir PET imaging to quantify cortical tau deposition, MRI, ultrasensitive digital immunoassay for plasma biomarkers, and comprehensive clinical and neurocognitive testing. Group differences in regional [18F]flortaucipir standardized uptake value ratios were assessed using analysis of covariance, and voxelwise Z-score mapping identified clusters of elevated tracer uptake (>2 SD above control mean). Linear regression analyses were conducted to examine associations between PET tau signal, plasma biomarkers, cumulative blast exposure and clinical outcomes. Special Operations Forces personnel exhibited significantly higher [18F]flortaucipir uptake in the frontal (P & 0.022) and temporal cortices (P & 0.037) compared with controls. Voxelwise mapping revealed tau clusters in 88% of exposed individuals, with nearly half localized to the frontal cortex. Elevated PET signal correlated with cumulative years of breaching, post-concussive symptoms, sleep disturbance and functional impairment. Plasma biomarkers showed converging evidence of neurodegeneration: brain-derived tau, glial fibrillary acidic protein and amyloid-β42 levels were significantly associated with regional tau PET uptake. A reduced amyloid-β42/40 ratio and elevated phosphorylated tau isoforms further supported early molecular changes consistent with neurodegeneration. Cumulative occupational blast overpressure exposure in Special Operations Forces is associated with frontal-predominant tau deposition and plasma biomarker signatures of astroglial activation, axonal injury and CNS-specific tau release. These convergent imaging and molecular findings support a link between repetitive blast exposure and early-stage tauopathy, and highlight the value of combined tau PET imaging and fluid biomarkers as non-invasive tools for early detection, monitoring, and targeted risk mitigation in blast-exposed populations.